-
Introduction: Chronicles of an Accidental Death
- The University of North Carolina Press
- Chapter
- Additional Information
introduction chronicles of an accidental death keith wailoo, julie livingston, and peter guarnaccia In February 2003 Jesica Santillan, a seventeen-year-old Mexican immigrant living illegally in the United States, lay unconscious in a room at the Duke University Medical Center in Durham, North Carolina. She was dying because of a stunning medical oversight. As the hospital spokesman explained publicly, Jesica’s surgical team had made a simple but tragic mistake in the hours leading up to her heart and lung transplant operation. Soon after replacing Jesica’s failing heart and lungs with healthy ones, the team discovered that the transplanted heart and lungs had come from a patient of a di√erent blood type. The donor organs were type A; Jesica was blood type O. As this frail young woman’s immune system slowly rejected the organs and as doctors scrambled both to keep her alive and to find another set of compatible organs, her story attracted international media notoriety as the ‘‘bungled transplant.’’∞ For the next few weeks, the case became front-page news. But as more and more details of the Santillan story emerged, the meanings of the story compounded and reverberated in remarkable ways, gradually becoming a story about medical error, immigration, and alleged medical tourism. The organ transplant story also made for a toxic collision between a wider world of human commitments, cultural values, and political ideals. Observers drawn from a wide spectrum of vantage points would come to characterize these events not only as an unfortunate personal tragedy for Jesica and her family but also as a prism through which profound problems in health care and American society came into focus. For some, the Santillan story was about illegal immigration and about foreigners taking resources that would otherwise have gone to American citizens. For other commentators , it highlighted an ongoing crisis of widespread error in medicine. The American media, cultural commentators, and politicians alike seized upon the Santillan story—for at the time (and still today) the story collapsed a range of pressing issues into one tragic narrative—questions about the promise and problems of high-technology (i.e., transplant) medicine, about the privileges 2 introduction of citizenship, about the principles that guide how we distribute scarce resources , about the right to sue for malpractice and about tort reform, and about the wider impact of such highly publicized high-profile media dramas on American society and beyond. The collective media portrait that emerged in February and March 2003 figured the character at the center of the transplant story as a complex transplant herself: an immigrant moving from one place to the next, looking for a brighter future; a sick child in need of a new heart. Press accounts o√ered thinly developed sketches of Jesica as a person, plugging her tale into a pastiche of preformed American immigration narratives. As one observer later put it, she had journeyed ‘‘from the shacks of Guadalajara to the selfproclaimed City of Medicine, as Durham is known.’’≤ Another story recalled that she was born Yesica in the village of Arroyo Hondo, Mexico, that her schooling stopped in sixth grade, and that after graduating in 1997, ‘‘Jesica worked as a maid in a neighbor’s house.’’≥ Work was scarce in this town of cane fields and a sugar mill. People were moving in the 1990s to larger cities like Guadalajara or looking for opportunities to cross into the United States. But the search for work was mentioned only rarely as an element in portraits of Jesica and her family. Most stories focused on the fact that her mother, Magdalena, had learned early in the girl’s life that Jesica had a weak and failing heart, that little could be done for her in Mexico, and that the United States o√ered the promise of lifesaving medical care. For some authors, the Santillan story was not only about a fateful medical error, it was about these broader demographic trends and the hopes of the immigrant community. In framing the story of the ‘‘bungled transplant,’’ some accounts mentioned that three years before the operation, Santillan relatives had pooled money to pay a smuggler to bring the family across the border—with the goal of finding medical care. By 1999, the family had arrived in the small town of Louisburg, North Carolina, where Magdalena’s sister and other relatives already lived and worked. They were part of a remarkable trend of ‘‘untraditional immigration’’ in the 1990s, as Mexican newcomers migrated to...